The Gastroesophageal Gastrointestinal Balloon

The causes of globus remain inconclusive, although several potential contributors to its presence have been suggested: gastroesophageal reflux disease (GERD), abnormalities of the upper esophageal sphincter (UES), and psychological/psychiatric disorders may all play a part in its manifestation.

Initial investigation of globus should include gathering a complete patient history and reviewing any associated symptoms such as reflux. Furthermore, nasolaryngoscopy must also be conducted.

Pathogenesis

Due to its inherent heterogeneity within tumors and among patients, its pathogenesis remains obscured by lack of diagnostic biomarkers or effective treatment approaches. Although genetic alterations and mutations associated with gastric cancer have been identified, its progression remains poorly understood. With modern genomic technologies at our disposal, it has become possible to study the genome-wide changes associated with gastric cancer by comparing gene expression profiles between normal and gastric cancer tissues. By identifying signature genes associated with cancerous phenotypes, molecular targets for diagnosis and therapy will become available that will enable us to defeat this deadly illness.

Two patients with autoimmune atrophic gastritis presented white globe appearance in their stomach. Endoscopy showed multiple white substances on mucosa of fornix and body but not on antrum mucosa; biopsy specimens revealed dilated glands with decreased parietal cells; neither patient had Helicobacter pylori infection and the microscopic findings differed significantly from others with white globe gastritis with similar manifestations; furthermore both individuals took acid secretion inhibitors, which likely induced hypergastrinemia and led to formation of white substance on stomach mucosa of fornix/body mucosa rather than on antral mucosaesae which caused hypergastrinemia which contributed to its appearance in subsequent stages; neither patient had Helicobacter pylori infection which would account for its formation resulting in this case!

To identify novel biomarkers, we compared gene expression changes between normal and GC tissues using a large-scale RNA microarray dataset (GSE63089 accession ID). Gene set enrichment analysis and network analysis were then applied on these results in order to recognize biomarkers differentially expressed between groups of samples. Our pathway enrichment analyses highlighted collagens and integrins as central players involved with ECM organization as well as EMT mechanisms. Furthermore, several genes linked with PI3K-AKT signaling and focal adhesion arrangement were highlighted among enriched pathways.

Cluster 2 revealed an increase in biological processes relating to neutrophil activation and immune system functions. We identified many genes involved in DNA damage response and repair such as RFC3, TOP2A and FANCI. These genes play an integral part in maintaining chromatin remodeling as well as maintaining telomere length maintenance, and may play an integral part in gastric cancer progression.

Diagnosis

Diagnosing globus can be challenging and may be misdiagnosed as one or more other disorders; examples include gastroesophageal reflux disease (GERD), abnormalities of the upper esophageal sphincter, psychological stressors and certain medications. A throat examination or endoscopy may be performed. Furthermore, an esophageal manometry test can reveal motor disorders which could contribute to or cause the sensation.[27]

Magnifying endoscopy with narrow band imaging (M-NBI) was recently used to identify an early gastric cancer marker called white globe appearance (WGA), a small white lesion with a globular shape under the gastric epithelium that increases in intensity towards its center and contains subepithelial microvessels. WGA has high diagnostic accuracy but limited sensitivity; meaning noncancerous lesions could also exhibit this characteristic.

Endoscopy with M-NBI has proven effective at diagnosing stomach inflammatory bowel diseases. Yao et al. proposed an endoscopic diagnostic algorithm based on vessel plus surface (VS) classification to diagnose gastritis; while Muto et al. reported tubulovillous patterns as the most reliable marker for gastritis on M-NBI endoscopy.

Before having the gastric balloon implanted, patients must undergo an endoscopy – this involves passing a thin flexible telescopic camera through their esophagus and stomach using an endoscope – in order to ensure there are no abnormalities which would prevent its placement. Procedure is generally pain-free and takes 30-40 minutes. An inflated balloon stays in your stomach for six months. In addition to aiding weight loss, gastric balloon therapy may also reduce symptoms associated with GERD. Gastric balloons work by partially filling the stomach, which activates satiety receptors and slows food evacuation from it. Candidates for gastric balloons typically have a body mass index of 27 or higher; it may also be used as part of a staged approach for patients too heavy for immediate surgical procedures.

Treatment

Gastric balloons offer temporary weight loss treatments for people with high body mass index (BMI) who cannot or prefer not to undergo surgical weight loss procedures, like gastric banding. An endoscopic procedure that places deflated balloons into your stomach helps reduce its volume and make you feel full with less food; they may be used either alone or as part of an effective staged approach for surgical weight loss, making this option suitable for treating issues like heart disease, diabetes and obstructive sleep apnea that improve with weight loss such as health issues related to obesity like these and others.

At first, the doctor will insert an endoscope into your mouth and thoroughly examine your esophagus, stomach and small bowel to ensure you do not have any conditions that would compromise a balloon such as hiatal hernias or ulcers that would preclude its safe placement. A catheter attached to the endoscope will then be guided directly into your stomach; upon reaching its destination point, a balloon filled with saline (roughly equaling grapefruit size) will then be placed over its opening and placed over its opening before filling it up to grapefruit size for placement.

Saline fills space in your stomach and increases satiety, helping you feel satisfied after smaller meals. Additionally, it slows the rate at which your stomach empties – both features helping weight loss. For the first week after surgery, only liquids will be permitted; thereafter you can gradually introduce foods back into your diet. In order to maintain proper positioning of the balloon you must maintain healthy eating patterns and an exercise program in order to prevent its displacement.

If you opt to have the balloon removed, sedatives and topical anesthetic or lubricants will be administered prior to surgery in order to ease removal. Once punctured and suctioned out, your doctor will perform another endoscopic procedure to puncture and extract from your stomach a second endoscopic procedure designed to puncture, suction and extract your balloon. In addition, they can help assemble an appropriate team for long-term weight loss efforts including dieticians and psychotherapists/psychologists.

Food can irritate your balloon, leading to cramping, bloating and pain. You may notice this if you eat solids within the first few days after having it removed – drinking clear fluids and sucking on ice cubes is recommended to help avoid this side effect.